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03060019 CITY OF CUPERTINO zs`s � 'yy�R'`�"�` - '�"�"`'� '�"�♦'I'6'' P,e BUILDING DIVISION PERMIT . COO 1�7tAkCTOR TN 't)RMA"CT . BUILDING ADDRESS: TERRY BROWN, GEN CONTRACTO -AOTNL0306OO19 10491 SCENIC BLVD IReR•sNAmE: 14510 BIG BASIN WY , pERMrr�4P"3/2003 ESE, MARY E . PHONE: 8 868-1640 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 s 05 LICENSED CONTRACTOR'S DECLARATION Job Description F 1 hereby affirm that I an lima.d under provisions or Chapter 9(commencing with Section 70110)hf Doidon S of Ne Bull.and Professions Code.and my licer.u ELECTRICAL REWIRE/FIXTURE, RELOCATION, ADD BATH 'o in full room adW.s ^ = Lisette"° Lte.g TO COTTAGE DEMENT AND SIDING o Comnmr ARCHITECTS DECLARATION IundcrsunJ my pl eti ,..... #IlJ1' DU 30t; Lcenttd Pmrnssianel .•�� 3 OWNER-BORDER DECLARATION i 1 hereby affirm Net I on exempt cram dOc CLicense w for Ne" ❑O fallowing sumo.(Swoon 7131.5,Business and Professionsing..Coo lade,Any city m•county K$9 which requires a permit ter cam(Swoon her.improve.dcmolixh,ar repair'any iductare .)A P prior m its issuance,also requires the applicant for such permit m file a signed stalmonty a t ionsValuation e < (camhat incingwApSectio 7000)to the 1 vivision3oxCamncmhndProlLimmiianCode)or Sq.F[. F1oorArea $ that he 4 (commencing Section and the basis for of did alleged usandon.fcadOnsetdC)of $26Op0 3.. Nato u 31.5 b therefrom and Ne nuts far Ne alleged exemption.to Any Wolnaon of Semon 7than five arty applicant for apemOit subjects the applicant anvil penalty of ��ee``IYN Number Occupancy Type - n�t mart than Ow hundmd dollars(5500). 3 D 706001 . 0 0 Cl L u hewer of ole pmpeny,re I. mintences with wages r Nei( ec.compensation, will dotrusions and WswcwmtsnmsLiceseded awdoesffiened orsal apply to N,Badness j�njljed Inspections and Pmfeselona Code:The COnmmors License Law lora hot apply m an owner of 101 — FOUNDAT I V iV p pro pa�vwho Wilds.rimprovu Nermn,andwho doessucn wort him.lforWaugh his 102 — PIERS owl employaw,provided that such Improvements are not intended aro@red forn4.If, however,W Wilding or imp onwmcut u sold within one year ofmmplehn,the.wher. 103 — UFER ( Wilder aw lder will hthe Widen of proving that M did not Wild Or improve for purpose of e104 — REBAR ❑I,as Owner or W pmpeny,am exclusively contracting with licensed contractors N 105 — ANCHOR BOLTS construct the project(Sec 7044,Business and Professions Code:)The Conmstai U. 106 — SEWER & WATER muse law does not apply to an owner of properly who Wilds or improves themon,and who comncts fon such projects withacoatraeter(s)licensed pursuant WNC Contractors 202 - UNDERFLOOR PLUMBING License Law. ❑Ism ax� tan em Sec. B&Pcmn is on 203 - UNDERFLOOR MECHANICAL him e ODaajj2f 204 - UNDERFLOOR FRAME WORKj:RS COMPENSATION OEC llAnON 205 - UNDERFLOOR INSULATION I hereby affirm under penalty of perjury onto Of the following declarsomu: 301 — ROUGH PLUMBING ❑I haveand will maintain aCet4NmmarCommdt mallf-mino Por Worker-Carolina- 302 — TUB .Sc OR SHOWER sanon.u provided fuer by Section 3700 Of she Labor Code,for the perform.of his ,work for which this permit is issued. 303 - ROUGH MECHANICAL ❑I lave soil will maintain Workers Compenudon Insurance,as nudad by Section 304 — ROUGH ELECTRICAL 370 of the LaWrCode,far Ne performance of the work for which this permit is sound, 305 — FRAME My Workers Compensation Insuumm ti rnier and Policy number art: carrier. Policy No.: 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS 307 — INSULATION COMPENSATION INSURANCE (This sectio.ad not he completed ifthe lermh is faro.hundmd dollm($100) 308 - SHEETROCK .leu.) 309 - EXTERIOR LATH 1 eerily that In the performance or the work for which this permit is issued,I shall net 310 — INTERIOR LATH employ any person in any mannerm as In bec.mcmb)em to the Workeo Compmssdon Laws of California.Dear 311 - SCRATCH COAT Applicant 313 - ROOF NAIL NOTICE TO APPLICANT:If.after making this Ccnificec of Exemption,you should become subject mW Worker,Compcnaadon provisions or Ne Labor Code.you must 501 - FINAL ELECTRICAL ENERGY ,J',Z forthwith comply with such provisions or Nispermitshallbodccmedrtws.d. SO2 — FINAL PLUMBING ENERGY i CONSIRUCnONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY 'Fr o-�+ k far whaffnm NetmcrttsaconsSee.3 .0 o. agency forNe Performance of Wwvrkmrwmmwspetmhtsitsuee(s«.3ty)y.ci¢c.) 504 - FINAL BUILDING ENERGY bol Und`r'sName 505 - FINAL ELECTRICAL j z Lenders Address U p I coolly Nat I haw mad Ws application and stats Nem the show bipartition un Ice 506 - GAS TEST {L Hcorrect.I agree to comply with all city and county ordinances and auto laws relating m 5 FINAL PLUMBING O V building construction,and hereby submits,mm phoseatives of this city O.enter upon the p W aMve.mentianedpmperlyfar inspcmionpugatts O$ QINNMECr�NG Lrand agree to save,indemnify and hemp hrtmless W City of Cupertino against 5 r^rA Ilinulitia,judgromm.cow and topmeas which may in any--mete against add Gly U I.moacguene.of the goading of this permit. APPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL ffrON-POINT Issued by Date Date 50FJiR sULA IONS. �js/ ` . / Re-roofs Si nu f oAppliaMCamonotor — I Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fmhm building Occupant stare or handle hosrdom material as defined by he Cupertino Municipal Code,Chapter 9.12,and its Health and Safety Code.Section 25532(a)+ ❑Yu 9iN//yy[['''' All roofs shall be inspected prior to any roofing material being installed. . Will the applicant or future building Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove emit haaa(dou air canuminams u defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yesfo I have mad the WnrdOms materials rtquiremmu undcrClupar 6.95 of W Califon ole Health&Safety Code,sections 25505,25533 and 25534.1 understand Nm if the building dins not c(mndy haw a a.m.that It is my responsibility u ofy the.cvpmt of the rcquirm mmusOW ma�Nr to iseumccnra CCNfream foot mjY. Signature of Applicant Date =7510' �- " G/3/d3 All roof coverings to be Class "B"or better Owner or soh ural agent D q — mol I ,off x I - i ` 10 I I I I I I �� I � � I �iil � _• ' .I i _�___�--.—I_. I , '-� I I 1-C.►L-__ � _� IJV!�—! ' _ , ' r I I ' RDI WIT f' 013 - U�FRT.I 0 DES 9P 1 qi let o la is shccifibeifo is 11 WTI j = _ of n alcr�ank, ch; ,nna�or {Ifefil 6hPL �- - c+- D same 'xitlu of �ntf,: p,rm a rlpn - T- O-rX cJaL h tp1mi inq jj ;jj,J >I�� '•n c�Irl lri��. I f— I �NAIjL N T b, iitll', ''' I, Ii It u v Y , .r1_ , __ISI Val a�tit�v }n hl DSI m^fc� �rh3Ll,x�, I - —}•--1 T— — LL — i , ,— I —j i • I �I I m� l I -T -i - - I- �-; - eon 1 �T_ —_f�j _ T l _l -� i I 7-T- .I I I 156 IF —�— I I , 1 —. InA.N ,o f I 1 P mN T IaN o rNARCIEs — o mon lin I,, it �— , I to lie II_iii _ l� I �-�--- - - ��--��- pit VIM 1. on I 1-71—1- i tz !L - --1 _ jam; LL —Li J-_-'1' -1 �-►_ �_��i- - I--!�� r--i AY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO I 7APN# _ ©o Date: Building Addres : 0 kc- Owner's LOwner's Name: Phone#: Contractor: I Lleense#: , i-J (tO WAJ -ZCo L Contact:_Tc / Cupertino Business License#: �/v Building Permit Info: Bld Elect Plumb Mech ❑ JobDescriptio E : c6CTRti ��1 lcgE FlxWAe- 2�ocA'ri +VoPOPPFSA-n4 —ro Crnr,\6 ✓ Residentialtio W 1 NOO+UJ RF cE+ a 4tT Vie}--& 51 D N SFI.Ft. Floor Area: _ $/Sq.Ft.: Cost of Project: Occupancy Group: tT v O C7 Type,of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/OfFCOmm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL __ BELEC1001 Elec 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL 4 , BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 y �l CI� *rY OF CUPERTINO TY°�- PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTMIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING r BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check.Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING l BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture I ELECTRICAL 2of3 CITY OF CUPERTUA 0140 PERMIT APPLICATION FORM CUp TING ' u nti Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch& Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing,Fees ,foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 ic 43-24'14" sc R= .001 L=4BL . VD. Jo 0, S82 9' 7 41' CD 1. 91' 20.00' 9 0 ui to y JTNT 2 T 1 Ft OA K Lo 10, 02 SQ S24'49'10"W Ao 9.54'/ j 16.;�XX 70.00' X_ A (I SPHALT DRIVEWAY 82-ol,21"IN I K 66.04' 20,00' "TO b Cj A k -CC EXISTING -U.) ice1-S TORY RESIDENCE, 2,313SQ. FT. LOT3,9 1 YJ36 SQ. FT., NET Y\ _99 ..tQ. FT;GROSS 71 U Io* IL 20.00' N87 56 W < / f. j 90.2.7' ...............—,-. -- ----